OBJECTIVES

Nonparametric frontier estimations are commonly used to measure the technical and cost efficiency of health service units. This research is composed of applications aiming at defining efficiency-based protocols for hospital beds evacuation and resource reallocation during the COVID-19 pandemic.

METHODS

Using Data Envelopment Analysis and Multiple Criteria Decision Making methodologies, we estimate the production capacity for hospitalizations considering each health service unit in Pernambuco, Brazil, and how much additional medical resource (costs, beds, nurses and assistants) each inefficient hospital should provide, based on best practices, if the number of hospitalizations was expected to increase according to different scenarios.

Based on expert knowledge elicitated from physicians, scholars and municipal authorities, we develop a prioritization ranking for medical specialties in these health service units for reallocating resources. The considered specialties are Gynecology, Psychiatry, Chronicles Diseases, Pediatrics, General Clinic, Orthopedics and Traumatology, General Surgery, Obstetrics, Cardiology, and Intensive Care Units (ICU), prioritized according to the criteria Severity, Flexibility, Complexity, Assistance Utility, and Potential for Replacement.

RESULTS

26 hospitals are working at full capacity in the state, serving as peers (benchmarks) for the remaining inefficient units. 3772 beds and 5037 human resources (mostly nurses) are feasible to be reallocated in one year for new COVID-19 cases by considering formalizations of new service protocols, postponing surgeries and decreasing the patients’ length of stay in hospitals through best practices from the peers. Individual slack measures are also provided. The most critical specialties are Cardiology and the Intensive Care Unit which, whenever possible, should not consider reducing resources for reallocations.

CONCLUSIONS

The proposed methodology, application and discussion are interesting for combining robust quantitative estimations with the active participation of policymakers and stakeholders in the process. The complex reality of hospitals can be interpreted through the economic perspective of efficiency analysis, which can help to prevent the collapse of health systems.